A Desai G Singh R Choudhary B Kapoor S Thacker CNST Audit 11/06/2010

 Why was the audit done?  What was monitored?  How was the data collected?  What are the findings?  Summary  Recommendations Outline of presentation

 CNST requirements Show approved documentation Show it is implemented Show it is monitored  Audit Use the approved documentation Monitor its implementation Introduction

Guidelines

 Induction of labour  Prolonged pregnancy  Previous caesarean section  Maternal observation – during induction  Fetal observations – during induction  Process for dealing with maternal requests  Review 1% of cases for 1 year Requirement of CNST (Level 3)

1) Prior to induction (prostin) 2) During Induction – 1 st 6hrs 3) During induction – 2 nd 6hrs 4) Post 12 hrs Monitoring - Stages

Monitoring – prior to induction

Monitoring – during 1 st 6hrs

Monitoring – during 2 nd 6hrs

Monitoring – after 12hrs

Information Sources

Collection Form Reason -Post term -Previous c-section Induction Method -Prostin -ARM -Cook’s Catheter -Foley’s Catheter Fetal Assessment -Auscultation -Movement -Both

 Total number of cases = 40 Case Notes Reviewed

Reason for Induction

Parity

Gestation

Risks Explained

Membrane Sweep

Method of Induction

Pre Induction CTG

Observations – Admission MaternalExamination

ARM on Admission

During 1 st Prostin (0-6hrs) Fetal AssessmentObservations

Post 6hrs Prostin CTG All Prostin PatientsPre 2 nd Prostin

Post 6hrs Prostin - Assessment

ARM post 6hrs prostin

Post 6hrs – Pre 2 nd Prostin

During 2 nd 6hrs – not ARM Fetal AssessmentObservations

During 2 nd 6hrs – 2 nd Prostin only Fetal AssessmentObservations

Post 12hrs - Assessment

ARM post 12hrs

Prostin Needed

Delivery Outcome Reason for inductionMethod of induction

CTG Stickers missing in notes

Summary of findings 35% had risks explained 98% had assessments 92% had CTG 88% had assessments 31% had regular observations 80% had CTG 80% had assessment ~50% had maternal assessment 60% had fetal assessment 78% had fetal assessment 20% had regular observations 80% had assessment

1) Risks explained to mother needs documentation on induction prescription form 2) Fetal assessments need to noted regularly after administration of prostin 3) Maternal observation and abdominal examination needs to be repeated before administration of prostin 4) CTG stickers must be include in the notes 5) Re-audit before end of November Recommendations